PANCREATIC CONDITION · CONDITION GUIDE
Chronic Pancreatitis
Progressive inflammatory disease of the pancreas causing chronic pain, exocrine insufficiency, and diabetes — treated surgically to relieve ductal obstruction and manage complications.
ABOUT THIS CONDITION
What is Chronic Pancreatitis?
Chronic pancreatitis is a progressive fibro-inflammatory condition of the pancreas leading to irreversible structural damage, ductal obstruction, and loss of both exocrine and endocrine function. The predominant symptom is severe, often debilitating abdominal and back pain. Other consequences include steatorrhoea from exocrine failure, diabetes mellitus, bile duct stricture, and pseudocyst formation. Dr. Tagore Mohan Grandhi manages surgical complications of chronic pancreatitis at Lux Hospitals, Hyderabad. Surgery aims to decompress the dilated pancreatic duct, remove inflammatory pancreatic head masses, or drain pseudocysts. The choice of procedure depends on ductal anatomy, the site of predominant disease, and the presence of complications.
SIGNS TO WATCH
Common Symptoms
Symptoms that need attention
WHY IT HAPPENS
Causes & Risk Factors
- Chronic excess alcohol consumption — most common cause
- Smoking — an independent risk factor that accelerates progression
- Hereditary pancreatitis from PRSS1, SPINK1, or CFTR gene mutations
- Autoimmune pancreatitis (IgG4-related disease)
- Recurrent acute pancreatitis from gallstones or metabolic causes
- Idiopathic — no identifiable cause in a significant proportion
CLINICAL DETAILS
KeyFacts
Alcohol and smoking in the majority of cases
Puestow, Frey, Whipple’s, Distal Pancreatectomy
Intractable pain, ductal obstruction, mass, pseudocyst
PERT required lifelong after pancreatic resection
Increased risk of pancreatic cancer — surveillance recommended
Available at Lux Hospitals, Hitech City, Hyderabad
HOW WE TREAT IT
Treatment Approach
Lateral Pancreaticojejunostomy (Puestow Procedure)
The Puestow procedure decompresses the obstructed pancreatic duct by opening it longitudinally and creating a side-to-side anastomosis with a Roux-en-Y loop of jejunum. It reliably achieves pain relief in patients with a dilated main pancreatic duct and is the preferred drainage procedure for suitable candidates.
- 1
Imaging & Pain Assessment
CT and MRI pancreas define ductal anatomy, identify strictures, pseudocysts, and vascular complications. Endoscopic ultrasound provides further characterisation. Pain management and nutritional optimisation are initiated.
- 2
Procedure Selection
Ductal decompression (Puestow or Frey procedure) is preferred for dilated duct disease. Whipple’s procedure is used for inflammatory pancreatic head mass. Distal pancreatectomy addresses tail-dominant disease.
- 3
Surgical Decompression or Resection
The selected procedure decompresses or removes the diseased pancreatic tissue. Bile duct strictures are addressed concurrently if present. Endoscopic stenting is used for selected ductal strictures.
- 4
Post-operative Metabolic Management
Pancreatic enzyme replacement therapy and diabetes management are instituted post-operatively. Alcohol and smoking cessation are strongly advised. Nutritional support and regular follow-up are maintained.
AVAILABLE TREATMENTS
TreatmentOptions
Lateral Pancreaticojejunostomy (Puestow Procedure)
Longitudinal opening of the dilated pancreatic duct with Roux-en-Y jejunal anastomosis for ductal decompression and pain relief.
Frey Procedure
Combination of coring out the pancreatic head and lateral pancreaticojejunostomy for disease predominantly affecting the head with a dilated duct.
Distal Pancreatectomy
Removal of the pancreatic body and tail for disease or strictures predominantly affecting the left pancreas.
Endoscopic Pancreatic Duct Stenting
Endoscopic placement of a stent across a ductal stricture to provide drainage in selected patients unsuitable for surgery.
COMMON QUESTIONS
Frequently Asked Questions
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